published_or_final_version / abstract / Psychology / Master / Master of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

published_or_final_version / Business / Master / Master of Philosophy

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

The goal of this report was to assess current prevention strategies that attempt to reduce HIV prevalence among female sex workers (FSW) in Honduras. This analysis was based on the difference between behavioral change and structural approaches; that is, while behavioral change theories are based on risk reduction through promoting individuals’ change, the structural approach addresses the factors in the environment that make individuals vulnerable to HIV. In order to analyze prevention strategies in Honduras, I carried out an analysis of the structural conditions at the country level and, at the sex workers population level. The structural factors that make Honduras a country vulnerable to HIV are political instability, migrations, poverty and socio-economic conditions, and gender inequality. As a consequence of those macro-environmental conditions, sex workers face the following micro-environmental factors that increase their vulnerability to HIV: violence and male domination; large families and single parenthood; low income and poor education; and public policies against sex work, such as police abuse and closure of brothels. This report is based on an analysis of the Sonagachi Project in India, 100% Condom Use in Thailand, and the intervention in the Dominican Republic, programs that successfully address structural conditions and decrease women’s vulnerability to HIV. This report showed that in Honduras, the prevention strategies currently implemented are limited because they are based on behavioral change theories, failing to address environmental barriers that increase vulnerability to HIV among FSW. I give some specific recommendations about how to improve prevention strategies in this country reducing women’s vulnerability by addressing the structural factors they face. / text

This ethnographic dissertation research project examines HIV prevention programs in Warsaw, Poland to explore the concurrent processes of democratization and privatization as Poland begins European Union accession. As inherently political public health interventions, HIV prevention programs provoke discussions of risk and responsibility, and visions of the moral social order. Therefore, they can be used to understand the ways in which politically and socially marginalized populations invoke claims to citizenship status through attention to health issues. From an epidemiological perspective, HIV/AIDS arrived in Poland relatively late (1985) and never reached the anticipated epidemic levels. In the 1980s, drawing attention to the potential threat of AIDS served as a forum through which the perceived failures of the socialist government could be publicly addressed. In the 1990s calls for improved access to AIDS information suggested that to be democratic meant to have open and easy access to scientific information, and debate surrounding the establishment of AIDS care facilities suggested that to be European was to be tolerant. However, issues of information and tolerance were problematic in reference to homosexuality. Prior to the advent of AIDS in Poland, socialist gender and sexual ideologies converged with Catholic notions of proper morality to marginalize and pathologize homosexuality. Nascent gay organizations saw the potential of HIV prevention as a way to justify the value of such organizations for the greater good of society. The possibility of controlling and participating in the task of HIV prevention presented an alternative to statesponsored surveillance under the guise of HIV prevention and encouraged public dialogue about the issues gays face in their daily lives. Whereas the national HIV prevention agenda focuses on risks as equally distributed across Polish society, a central component of the HIV prevention programs within Polish gay rights and drug abuse prevention organizations is harm reduction. As practiced by Polish gay organizations, a harm reduction philosophy draws attention to heterogeneity within gays and challenges the construction of them as a coherent risk group. These programs deemphasize sexuality in favor of a wider constellation of factors that contribute to finding oneself in situations that can lead to risky behavior.